Forms

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Financial Policy Form

Patient Information Form

Minor Authorization Form

Record Release Form

Adult Medical History

Pediatric Medical History

Allergy/Asthma Medical History

Ear, Nose and Throat Medical History

Voice/LPR Medical History

Sleep Medical History

Privacy Policy

School Medical Forms

Clovis Unified Medication at School & Anaphylaxis Emergency Action Plan

Fresno Unified Medical Form

Visalia Unified Medical Form

Accepted/Contracted Plans:

  • Advantek PPO
  • Aetna Choice/PPO
  • Anthem Blue Cross PPO
  • Blue Cross PPO
  • Blue Shield PPO
  • Capitol Administrators
  • Champva Open Access
  • Cigna PPO
  • Foundation for Medical Care
  • GEHA
  • Health Net PPO
  • Humana – Choice Care PPO
  • Interplan PPO
  • Key Medical HMO with PMD Referral
  • PHCS PPO
  • Triwest (Tricare)
  • United HealthCare PPO/Choice Plus POS